391: Preventing Burnout by Examining your Emotions with Dr. Shawn C. Jones

Pete Mockaitis
Dr. Jones, thanks so much for joining us here on the How to be Awesome at Your Job podcast.

Shawn Jones
It’s great to be with you. Thank you Pete.

Pete Mockaitis
Well, I’m excited to dig into your good stuff. Maybe we’ll start with your story, which is pretty compelling. What’s your tale when it comes to experiencing burnout?

Shawn Jones
For me it really started one morning, in retrospect, when I was getting ready for surgery. I was shaving actually and I recognized I wasn’t feeling anything. It really brought a sense of abject intellectual terror in the sense that I recognized I was experiencing absolutely no emotion. I subsequently did what any well-training highly-functional professional would do and I ignored it hoping it would go away and of course it didn’t. It worsened.

Part of my difficulty was that – and I think the difficulty with burnout for a lot of people is that it’s a very disorienting experience, so it becomes troublesome to try to figure out why you’re not feeling quite right and what’s going on. Actually it was the assistance of my wife, Evelyn, who nudged me to get some help and to look into things. That sort of took me down the road of getting some outpatient intensive psychotherapy.

I was subsequently diagnosed with post-traumatic stress disorder-related depression. It primarily was work-related stress that caused me to end up there.

Pete Mockaitis
Tell me a little bit about the work-related stress. What was going on? PTSD you often think of in terms of war time or trauma/tragedy, and here it was work-related. What was going on at work?

Shawn Jones
Well, I sort of personally liken burnout to, in terms of the work-related stress aspect of it, to sun exposure. You can certainly go to the beach and in one day get totally burned, but you can also over a period of time get small amounts of sun exposure that result in you having the development of a skin cancer or something else.

I don’t think we recognize as well the more chronic forms of PTSD, but all of experience some traumatic things in our lives. Sometimes if we don’t emotionally unpack those, I think they sort of always reside in the midbrain in the part they call the amygdala that remembers those things.

Particularly as physicians, we experience a lot of things that would shock or dismay or be an assault on the emotions and other aspects of our personality for normal people. We’re trained to deal with that, but over a period of time it sort of builds up and if I think you don’t deal with that in some way in a healthy way and unpack that and process it in a healthy manner then it can kind of rise [sic] up it’s ugly head and grab you and that’s what happened to me.

That’s part of the whole purpose behind my book was to raise awareness about how you don’t have to have an absolute blow out where something huge happens. It can be sort of a slow leak that takes your energy and your enthusiasm for life away.

Pete Mockaitis
In your book, Finding Heart in Art, what would you say is the big idea there?

Shawn Jones
I think that knowing that a sense of presence and awareness about who you are and your purpose can really drive you to staying true to yourself. It’s hard to give yourself to anything, to your profession, to your family, to your friends if you’re not in possession of yourself. Maintaining the connection to who you truly are and the true self is part of that. I think finding beauty in the world is part of what helps keep us healthy in that respect.

Pete Mockaitis
Interesting. I’d love to get your take then in terms of what are some of the practices associated with getting that connection back and keeping that connection strong proactively.

Shawn Jones
The three primary ways in which burnout are experienced or is experienced is through emotional exhaustion, depersonalization, and a loss of a sense of accomplishment in the work that you do.

Particularly with respect to medicine, but a lot of work is steeped in deep fundamental meaning, it’s hard to figure out how in the world you would ever lose that. How could someone not feel a purpose or a calling or a real significance to doing that kind of work, whether it be fireman, policeman, CEO of a large corporation?

Quite frankly as that burnout envelops you and the emotional numbness takes over, nothing you do seems to matter, so coming back to center and recognizing the truth of who you are and why you were called to do what you do is partially rekindled as a result of reconnecting to life again.

That is done through the emotions, which are the voice of the heart according to the psychologist, Chip Dodd, who wrote a book called The Voice of the Heart. They’re not our heart, but they are the expression. The emotions are the voice of our heart, their outward expression.

Experiencing fully fear, loneliness, hurt and being willing to do that, then you get the gifts that those offer you, which are the fullness of living in what is essentially a tragic place and that connection to yourself, then you think you can experience through the recognition of media. It might be for me observing or looking at Renaissance art. For you it might be hiking Elephant Loop trail in Yellowstone. For another it might be making a guitar.

There are all sorts of ways in which we connect with who we are and become true to ourselves in an artistic sense. Part of that expression I think helps enliven us/enrich us and is one of the reasons those activities are referred to as the humanities because they have a way of keeping us human.

Pete Mockaitis
That’s really intriguing here. When it comes to – you laid out three causes: emotional exhaustion, depersonalization, and the loss of the sense of achievement and significance. You’re saying that experiencing fully the not so pleasant emotions can actually be helpful and preventative against burnout?

Shawn Jones
Well, I think to a degree if you think about it, all of those things that I mentioned, fear, hurt, loneliness, anger, guilt, they are part of being human. One of the things that tends to happen when we experience them is we don’t like them. We don’t like the feeling that they bring, so we want to pack them away and not deal with them. Over a period of time that emotional detritus, if you will, builds up.

They are going to have their say one way or the other, but dealing with them allows you – for example, if your foot hurts, it might be because you have a cut on it. Recognizing that hurt and addressing it and bandaging it, caring for it, brings you the gift of healing. Each of the emotions are like that. They have a gift that they give you as a result of their full experience that you deny yourself if you aren’t fully willing to enter into them.

Part of being a surgeon, for example, is emotions don’t help me a lot when I have an emergency operation to perform at two in the morning. We’re trained in a sense and rightfully so to take our emotions about the experience at that moment and set them aside. I think sometimes, certainly I did, got so good at setting them aside, I never got them back out again.

I think that’s one of the reasons you’re seeing really an epidemic in burnout amongst physicians is because we haven’t been historically trained to get those feelings back out and look at them. I think that’s one of the reasons why … are having difficulty with that now.

Pete Mockaitis
I’m curious to get your take on it in terms of in practice what does that look like in terms of what you do in terms of, okay, I put an emotion aside and then later on I’ve got some quiet, some opportunity to work with it. What do you do next?

Shawn Jones
I think that’s really important because we all, we know that there’s a lot of data that suggests that isolation and being alone is dangerous for human beings. We all crave connection and relationship in whatever form for each of us that takes. Living in a community and having someone with whom I have a trusting relationship to unpack those feelings in a way that can be beneficial to me.

Even sometimes nobody has to fix anything per se, but to just listen to what I experienced and acknowledge the grief, the anger. “Yeah, that really sounds like that was difficult. What was that like? Wow.” Just having that connection with someone I think I really beneficial to experiencing the gift of having those feelings.

Then as we talked about before being true to who you are. Sometimes we get so busy and there’s so much screen time and busyness in every day, we never stop to take account of where we are and what we’re doing and being truly present in the moment.

Mindfulness is one thing that’s been shown to be really beneficial in helping to be able to center in that moment and be aware of what you’re actually experiencing, which makes it really helpful to come back later even if it’s necessary and unpack those feelings again at a later time.

Pete Mockaitis
When you say mindfulness, are we talking about meditation in terms of just sitting quietly and returning your thoughts to breath or how are you thinking about mindfulness?

Shawn Jones
Well, I think there are a lot of different ways you can do that. Mindfulness space stress reduction is popularized by John Kabat-Zinn, an Emeritus professor at University of Massachusetts, who has created a program there.

He essentially studied Buddhism. As he would describe it I believe in paraphrasing took the trappings of the religion or Buddhism out of that and used mindfulness as a way to center on the breath or other types of things that helps your pulse rate and does all sorts of beneficial things from not just your ability to monitor your body, but it is also been shown to do some really interesting things.

Richard Davidson, a professor at the University of Wisconsin, has demonstrated that never-before meditators do ten minutes of meditation three times a week for three months compared to a same group of non-meditators who don’t meditate. If they’re given a flu shot, the meditative group has triple the antibody response to the flu shot that the non-meditating group has. It improves immune function.

It has all sorts of benefits I believe that we haven’t really figured it out yet in terms of research, but it’s really been probably one of the most beneficial things to come out of neuroscience research in my opinion in the last ten years is some of that data that talks about mindfulness.

You can also for instance talk about meditative practices that are within the spheres of religion some people would have more comfort with for a lot of different reasons that is the desert fathers of the Christian stripe in that sense, like St. John of the Cross, the Cloud of Unknowing. Rumi was a Sufi mystic who meditated.

There are lots of traditions. All of them seem to have benefits to them, but meditative practices in general I think are very good at being able to discern and to let go and to be present in the moment.

Pete Mockaitis
That’s a real nice lineup there. I had not heard the study about the flu shot. That’s fascinating. We talked a bit about the emotional piece. What do you mean by depersonalization?

Shawn Jones
A classic example from medicine would be to speak of a patient in a very impersonal way, like “The gallbladder in room 247.” While in some respects, depending on the circumstance, that might be appropriate because of HIPAA and other things like that, that tendency to not relate to people as on a personal basis puts in a distance between you.

I think in that sense, the electronic health record in medicine has been a severe impediment to that when you hear stories of patients going to see physicians and the physician the whole time they’re in the examination room are typing on the computer.

Pete Mockaitis
Yeah.

Shawn Jones
It’s not a human-to-human interaction. I think the same sorts of things are happening in corporate boardrooms around America, where people are on their phones and not present. I mean really present in board meetings and things of that nature. The technology that is meant to connect us is actually disconnecting us in many ways.

Pete Mockaitis
Right, so then in terms of your daily workday experience, what are some sort of simple ways we can bring the personalization back into it?

Shawn Jones
Well, I think a lot of this really requires intention. I have to set out with purpose on a daily basis to live my life a different way because it is so easy to get caught up and swept away in the moments and movements that occur to us when we’re very busy.

I think starting the day with purpose even if it’s just five or ten minutes of some meditative or centering prayer/practice is really helpful because it sets the agenda for the day just like you would if you were going to set the agenda for a phone call.

When you feel yourself getting out of control and sort of losing and being distracted, meditative practices will help you be able to take a moment, breathe, remember what you set your intention for that day, re-center yourself. That helps you, again, to be present, to not live in the past, not live in the future, but be truly present in the moment, which allows you to respond to situations and particularly crises in a way that is more appropriate for the subject and the event at hand.

I think those are two things that are really important. The other thing I’ve personally really tried to work on is what I think people refer to as mindful listening. That is making sure that when someone else is speaking that I’m looking them directly in the eye and I’m listening intently to their words and not planning on my response or what I’m going to say or how I’m going to interject.

I think those are three things that have really helped to make a difference on a day-to-day basis.

Pete Mockaitis
Now, when you set an intention, what does that sounds like in practice?

Shawn Jones
Today I’m going to make sure that I’m not going to be distracted. I’m not going to try to multitask. I’m going to be on task during the day. I’m going to listen intently to people and if I feel myself starting to become angry or to even respond and behave in a way, which I’m not inclined to want myself to be like, then I’m going to stop and pause and be intentional about taking control of that moment.

Just knowing that and setting that intention during the day – sometimes I’ll be in the middle of the day and it will all of the sudden hit me, I need to stop here for a second and sort of re-center myself and do what I said I was going to do today because I feel myself rising up in an emotional way in a sense.

I think that really helps because sometimes you can get carried away. People will come up and they’ll say something, “Oh Dr. Jones, you’re really going to be angry about this.” Before I even hear what the issue is, I’m already like, “Yeah, I’m going to be angry.” It sort of it helps to kind of take a breath and make sure that you’re being you and present in the moment.

Pete Mockaitis
Absolutely. I’d also want to get your take on the lever there or the factor that loss of achievement and significance. Do you have some thoughts for keeping connected to that when you’re in the midst of work?

Shawn Jones
That was very difficult for me because I completely lost my sense of purpose to a degree. Somewhere deep down I knew that I’d always wanted to be a physician. I was one of those kids that even though no one in my family had been to college, I knew I wanted to be a doctor when I was five or six years. I never wavered from that.

Deep down I knew that was really who I was, but I just wasn’t feeling like I was accomplishing much of anything. There wasn’t any sense of satisfaction there. Mostly it was because I’d lost myself. I had become detached from my inner emotional environment in a sense.

I think finding that purpose is great. The last thing I think anyone ought to do when you’re feeling burned out is to make a quick decision and change jobs or get out or – I think it really is important for people to take stock of what’s going on and try to get some perspective on it.

Because I think, for me at least, the purpose was there all along. It was the way in which I’d engaged that purpose. I thought by working harder, longer, faster, more that I would find it again. Actually, I needed to do just the opposite. I needed to step off for a moment, take a rest and re-examine that and find me.

Because compassion is the recognition of suffering and the desire to do something about it, to alleviate it in another human being. It’s pretty normal, natural human response to suffering. But when you have compassion fatigue, which is part of that burnout spectrum, you lose the sense of your purpose, so having that compassion rekindled and recognizing that you can only give what you have, it’s really important that you have yourself to be able to give it yourself.

Many of us need to have more compassion with ourselves because we become very negative in our self-talk and that isn’t helpful in developing compassion towards others. Compassion is contagious and I think the more that we extend compassion towards others and towards ourselves then the more compassion we’re going to experience.

Pete Mockaitis
Well, yeah, it’s funny when you talk about you’re feeling sort of under-resourced, tapped out, you’re less likely to act compassionately that reminds me of the study of the seminarians who had to turn in a paper. I believe it was about the story of the Good Samaritan. Half of them were told that they were late. The other half was not. I imagine you’ve encountered this in your work.

Then they encountered someone who was just coughing tremendously, like directly in their pathway. Those who were told that they were running late or that the deadline was very near, with alarming frequency just totally blew right by the guy versus those who did not feel they were that rushed were able to stop and help. These are seminarians who had just recently covered that story.

Shawn Jones
Studied the Good Samaritan. Yeah. It’s amazing I think sometimes once we get headed in a direction, how hard it is to turn ourselves about, but that’s a great example of what it means to actually put into practice what logically you’ve put into a different part of your brain.

Pete Mockaitis
When you’re compassionate with yourself in the midst of negative self-talk, what does the corrective or compassionate response to, it’s like, “Oh, I screwed up. I’m such a moron. Oh, I did it again.” It’s like, “Why can’t I ever get my act together with this?” kind of whatever. There’s the beat up self-talk. Then what is the intervention self-talk sound like?

Shawn Jones
There’s a loving kindness meditation. Actually there’s a free eBook called Compassion – Bridging the Science and Practice that’s available. If you Google that online, you can pick it up. It was developed a combination of some of the best neuroscientists in the world. In fact it was at the Max Planck Institute in Germany in cooperation with Buddhist monks who underwent functional MRI scanning. It’s got videos and tutorials.

But loving kindness mediation is essentially is, “I feel good. I am good. I want the best for me. I want the best for other people. I desire only what is good in life and want to extend mercy and compassion and grace.” Really, it sounds almost too good to be true.

The first couple of times I did it, you feel kind of foolish looking in the mirror doing that sort of thing, but it is amazing how that comes back to you at times when the negative self-talk will begin to pop up. There’s really a plethora of data that suggest that those who have a greater profundity of negative self-talk are more susceptible to burnout. It really is important in terms of trying to mitigate against the effects of burnout that you work on some of those.

There’s basically two ways you can try to affect burnout. One is by increasing your resilience. Those are the things like mindfulness space stress reduction, making sure you get plenty of sleep, eating correctly, exercising, all the things we know that we need to be doing and be diligent about in terms of our discipline.

But then there’s also decreasing the work-related stress, making sure you set aside time to do the projects you need to do in a concerted way, being intentional about what you want to do during the day and not being distracted, making sure you limit your screen time as much as you can. Even with me I know that’s difficult because screen time is important for the electronic health record.

But doing the best we can to mitigate the things we know that organizationally cause stress because Christina Maslach, who’s done as much work on burnout at a corporate level than anyone, with Michael Leiter wrote a book in 1997 called The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.

She said in that book that burnout is an organizational problem. It’s not a failure of people on an individual level. It is an organizational issue. Addressing it at that level is much more complicated and much more difficult because the things I’ll tell you to do in a hospital to decrease stress and burnout, might not work at Procter & Gamble, for example, or other – Google and Apple and things like that.

It’s going to be more generic recommendations about how to decrease stress, so it makes it more difficult to make application in each individual sense from an organizational standpoint.

Pete Mockaitis
Nonetheless, I’ll take a couple generic recommendations if folks find themselves in a leadership capacity, whether it’s for a couple direct report or for thousands, what are some of the generalized best practices to help prevent the burnout?

Shawn Jones
There’s an interesting study that says Americans more than any other culture, generally don’t take their vacations. I think one of the things that really would … is have their people take their vacations. It’s important for the work you do here for you to have time off. We give you that time off and we want you to take it. It’s not a negative and you’re not going to be a hero by not taking your vacation. I think that’s a pretty simple one to institute.

Then be really willing, as we talked about earlier, to listen to people about the things that cause organizational stress. With physicians, for example, and this is true of other leaders, if you allow one of your best workers to do what he thinks is most important 20% of the time, his risk of burnout is reduced 3 times. You can have him doing things he’s really not as interested in 80% of the time if he can do what really charges him up at work 20% of the time.

Finding out what people really are interested in and want to do in their job that fits your job description, the purpose of management in organization in my view is to fulfill the mission of the organization but to allow people the room and the space to accomplish that task while fulfilling the mission of the organization.

Sometimes that’s simply getting out of people’s way and not micromanaging them because that feels a lot of times like mistrust. If you don’t think I’m able to do this job and so you’re going to tell me how to move the widget from A to B and B to C when I’ve got a better way.

Pete Mockaitis
What’s also intriguing about that 20% guideline is that person may very well have a clearer, more accurate, astute perception of what truly is most important than the leader or the manager in terms of so it’s not just work 20% of your time on whatever the heck you kind of feel like doing and playing Candy Crush on your phone, but it’s like – it’s projects related to the organization that you find to be important.

Shawn Jones
Absolutely.

Pete Mockaitis
That’s pretty powerful.

Shawn Jones
Yeah. I’m sure Candy Crush is important somewhere, but it wouldn’t be in most places.

Pete Mockaitis
I’m researching the competitors on addictive app best practices. Cool. Well, Shawn, tell me, anything else you want to make sure to mention before we shift gears and hear about some of your favorite things?

Shawn Jones
I think that being really interested in ways to remain healthy in general is a way to incorporate this idea about burnout into your daily life. Most of us have an idea of the things we want to do on a daily basis to remain physically and otherwise healthy. This would just be putting another piece of that into that pie. It doesn’t take a lot of time. It just, again, takes some decision making process and some intention.

Pete Mockaitis
Well, now could you share with us a favorite quote, something you find inspiring?

Shawn Jones
I really think that one by Cynthia Bourgeault is compelling to me. “What the caterpillar calls disaster, the master calls a butterfly.”

Pete Mockaitis
Thank you.

Shawn Jones
What I like about that is there’s so much that we do not have control over in this life. Things happen and many times we react to that in ways that reflect our dislike of what’s just occurred, but we don’t know how the story ends. Many times when we look back what we thought was really a horrible thing that happened to us in our life turned out to be one of the best things that could have ever happened.

I think it’s important to recognize when we’re in that moment to realize there may be something else at work and to be open to those possibilities.

Pete Mockaitis
How about a favorite study or experiment or bit of research?

Shawn Jones
The one about the meditators with the flu shot response is one. But there’s another one in kindness research, where a researcher took a blue and a pink elephant and he presented them to very young children, 18 months and younger.

The first elephant, the blue elephant, would – a duck would try to open a box and the elephant every time would jump on the box and keep him from opening it. Then they would show a video with the pink elephant and every time the duck would try to open the box, the pink elephant would come over and help him open it. 95% of the children when presented with both elephants chose the pink elephant.

What that says in essence is that all of us are attracted to compassion and kindness. That’s what we innately are born with in many respects. It says something I think about the heart of human beings and the recognition of what we all desire in a certain sense and what we’re attracted and what we want to be. To me it really makes me feel hopeful for the world.

Pete Mockaitis
Yeah, that is very powerful. I’m going to be chewing on that. Thank you. How about a favorite book?

Shawn Jones
A favorite book. I’ve been really enamored with historical biographies. I would say that Washington Irving wrote a biography of George Washington that was thoroughly researched. Part of it is how well it is written and the fact that Irving knew contemporaries of George Washington that were amazing.

But the character and integrity of George Washington is absolutely outstanding in reading the book and the kind of man he was and the kind of – the way he comported himself in different situations, absolutely courageous, was spellbinding for me.

Pete Mockaitis
Thank you. How about a favorite tool?

Shawn Jones
I think for me mindfulness is my favorite tool. It has in many ways transformed my daily life as well as my inner life in a way that has been so helpful for me in so many respects. For me, mindfulness would be that tool.

Pete Mockaitis
And a favorite habit?

Shawn Jones
I enjoy exercising. Believe it or not if you saw me you wouldn’t think I liked powerlifting because I’m 5’ 10’’ and about 175 pounds soaking wet, but I really like deadlifting and squatting and doing Romanian deadlifts. There’s a lot of data that suggests that as you age maintaining muscle mass and functional strength improves your overall health. I enjoy doing that a couple times a week. It really helps me kind of unwind.

Pete Mockaitis
Can I put you on the spot and ask about the weights that you’re lifting?

Shawn Jones
Sure. I will do my best not to make this a fish story. I will tell you that I was in a gym not too long ago with a friend and he was lifting what he thought was a really great deadlift weight, like 350 pounds. A gentlemen came over and said, “Are you finished with that weight?” He said, “Yes.” Then he picked it up and did bent over rows with it. It was like, okay, we’re not at that level. But at first we thought, “Wow, this is really good.” But, yeah, my max deadlift is around 350.

Pete Mockaitis
All right, nice work. Nice work. Is there a particular nugget you share that really seems to connect and resonate for folks?

Shawn Jones
I think the idea that we all are attracted to the beautiful things in life and what beauty means to each of us is different. One example of that is if you look at the Renaissance masters, the early Renaissance masters, their idea of beauty was perfection. Nicholas Poussin, if you look at his paintings, there’s no dirt, there’s no grime – everyone is perfect.

It’s just beautiful, but it is a different aspect of beauty than if you look at the later Renaissance and the Dutch masters such as Rembrandt or Caravaggio where there is realism there. There is darkness and light. Mixed in with that is the beauty of the relationship between the people and the paintings.

For example, The Return of the Prodigal Son of Rembrandt, it is astounding how seemingly grimy and dirty and torn the clothing can be and yet overall it is aesthetically so deeply moving and beautiful. I think that’s a reflection of life. We have to look for the beauty in everyday life. If we look for it, we’ll find it. It will astound us and it will enliven us and enrich us, but we have to look.

Pete Mockaitis
If folks want to learn more or get in touch, where would you point them?

Shawn Jones
My website is DrShawnCJones.com. That’s S-H-A-W-N for Shawn. They can follow me on Twitter at ShawnCJonesMD.

Pete Mockaitis
Do you have a final challenge or call to action for folks seeking to be awesome at their jobs?

Shawn Jones
I think setting the intention and if you’ve not tried mindfulness or some meditative practice, it is very easy to start and there are a couple of apps even that will do it as much as I hate pointing to technology. Last night actually on NBC news there a story on Headspace, but there’s also one called Calm, which is very good, which is a great way to start without having to go to a class or do anything where you’re putting yourself out there.

Pete Mockaitis
Well, Dr. Jones, this has been just – it’s been profound and beautiful. Thanks so much for taking this time and good luck in all you’re doing in helping to heal medical burnout and your other adventures.

Shawn Jones
I appreciate it, Pete. Thank you. It’s been great to be with you.